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Multi-morbidity predicted to increase in the UK over the next 20 years
- Author:
- NATIONAL INSTITUTE FOR HEALTH RESEARCH. Dissemination Centre
- Publisher:
- National Institute for Health Research
- Publication year:
- 2018
- Place of publication:
- London
This NIHR Signal looks at the findings of a study which ran a computer model using data on over 300,000 people from three UK population surveys to predict changes in multi-morbidity between 2015 and 2035. The study found two-thirds of adults aged over 65 are expected to be living with multiple health conditions (multi-morbidity) by 2035. Seventeen percent would be living with four or more diseases, double the number in 2015. One-third of these people would have a mental illness like dementia or depression. The increase will place greater demand on all areas of health and social care and highlights the need for commissioners to ensure adequate provision of services. It also supports the on-going public health focus on health awareness and disease prevention. NIHR Signals highlight examples of important research and explain why the study was needed, what the study found and the implications of the findings. They include commentary from experts, researchers and those working in practice. (Edited publisher abstract)
Projections of multi-morbidity in the older population in England to 2035: estimates from the Population Ageing and Care Simulation (PACSim) model
- Authors:
- KINGSTON Andrew, et al
- Journal article citation:
- Age and Ageing, 47(3), 2018, p.374–380.
- Publisher:
- Oxford University Press
Background: Models projecting future disease burden have focussed on one or two diseases. Little is known on how risk factors of younger cohorts will play out in the future burden of multi-morbidity (two or more concurrent long-term conditions). Design: a dynamic microsimulation model, the Population Ageing and Care Simulation (PACSim) model, simulates the characteristics (sociodemographic factors, health behaviours, chronic diseases and geriatric conditions) of individuals over the period 2014–2040. Population: about 303,589 individuals aged 35 years and over (a 1% random sample of the 2014 England population) created from Understanding Society, the English Longitudinal Study of Ageing, and the Cognitive Function and Ageing Study II. Main outcome measures: the prevalence of, numbers with, and years lived with, chronic diseases, geriatric conditions and multi-morbidity. Results: between 2015 and 2035, multi-morbidity prevalence is estimated to increase, the proportion with 4+ diseases almost doubling (2015:9.8%; 2035:17.0%) and two-thirds of those with 4+ diseases will have mental ill-health (dementia, depression, cognitive impairment no dementia). Multi-morbidity prevalence in incoming cohorts aged 65–74 years will rise (2015:45.7%; 2035:52.8%). Life expectancy gains (men 3.6 years, women: 2.9 years) will be spent mostly with 4+ diseases (men: 2.4 years, 65.9%; women: 2.5 years, 85.2%), resulting from increased prevalence of rather than longer survival with multi-morbidity. Conclusions: The findings indicate that over the next 20 years there will be an expansion of morbidity, particularly complex multi-morbidity (4+ diseases). The authors advocate for a new focus on prevention of, and appropriate and efficient service provision for those with, complex multi-morbidity. (Edited publisher abstract)
Aging with hemophilia: implications for social work practice
- Authors:
- ALLEN Karen Neuman, KACHALSKY Ellen
- Journal article citation:
- Social Work in Health Care, 49(4), April 2010, pp.327-344.
- Publisher:
- Taylor and Francis
- Place of publication:
- Philadelphia, USA
The development of clotting factor replacement products means that individuals with haemophilia and other congenital bleeding disorders can expect to have an almost normal life-span and as a consequence face conditions associated with “normal” aging. Haemophilia along with the co-morbid conditions of transfusion acquired HIV and Hepatitis C complicate treatment for heart disease, cancer, kidney disease, and other age-related diseases. Lack of understanding of the condition, its treatment, and its costs hampers care, particularly when patients are treated outside of specialty clinics. This article provides an overview of bleeding disorders emphasising age-related considerations. The role of social work in specialised haemophilia treatment centres is described and suggestions made for other social workers who may encounter this population in their practice. Three case studies are included clearly illustrating the issues around communication and collaboration in managing continuity of care. Policy and advocacy implication are also addressed.
Evidence review for adult social care reform: summary report
- Author:
- GREAT BRITAIN. Department of Health and Social Care
- Publisher:
- Great Britain. Department of Health and Social Care
- Publication year:
- 2021
- Place of publication:
- London
Summarises the evidence review for adult social care reform. Its main purpose is to outline trends and challenges based on the current (as of 1 December 2021) adult social care system in England. It is a technical paper summarising the existing evidence that has informed the development of policy proposals. Data and evidence are presented on: changes in the numbers of people with care needs and the nature of those needs; current levels of formal care; the interface with wider systems, such as the NHS, housing and benefits; important factors influencing the resilience of the current system, including characteristics and availability of unpaid care, challenges in the providers’ market, workforce pressures. Evidence is strongest concerning demographic change and how this will substantially increase demand for care, though this will vary across the country and between socio-economic groups. (Edited publisher abstract)
Evidence review for adult social care reform
- Author:
- GREAT BRITAIN. Department of Health and Social Care
- Publisher:
- Great Britain. Department of Health and Social Care
- Publication year:
- 2021
- Pagination:
- 125
- Place of publication:
- London
The report collates a wide range of evidence on challenges and changes facing social care in England and what is driving them. The evidence is clear that both the absolute numbers of over 65s, and the proportion of the population they represent, are growing. People are living longer (although the impact of COVID-19 on long-term life expectancy trend is still unclear). However, as people live longer, many are spending more years in ill health, with complex health needs or disabilities. Similarly, there is an increasing number of adults under 65 with disabilities. This is driven in particular by more people with learning disabilities being diagnosed and supported, and many are now living longer than they did in previous generations. Overall, the total number of users of long-term adult social care in England is projected to increase by 50% between 2018/19 and 2038/39. This would mean total expenditure on adult social care services under the current, unreformed, system would more than double in real terms, from £28bn to £56bn (2018 prices), over the same period. The evidence shows significant variations both in care need and system capacity across the country. There is also significant variation in health and disability between socio-economic groups. The increasing prevalence of long-term conditions and complex comorbidities, driven in part by factors such as rising obesity rates, may require different models of care. Other drivers of ill health such as poor or inappropriate housing, and changes in living arrangements that affect people’s ability to care for themselves, may also increase future demand for care. At the same time, issues such as workforce turnover and a fragmented provider market are potential barriers to the system responding, for example through new technology that could help manage that demand. (Edited publisher abstract)
Premature frailty, geriatric conditions and multimorbidity among people experiencing homelessness: a cross-sectional observational study in a London hostel
- Author:
- ROGANS-WATSON Raphael
- Journal article citation:
- Housing Care and Support, 23(3/4), 2020, pp.77-91.
- Publisher:
- Emerald
Purpose: The purpose of this paper is to assess frailty, geriatric conditions and multimorbidity in people experiencing homelessness (PEH) using holistic evaluations based on comprehensive geriatric assessment (CGA) and draw comparisons with general population survey data. Design/methodology/approach: Cross-sectional observational study conducted in a London-based hostel for single PEH over 30 years old in March–April 2019. The participants and key workers completed health-related questionnaires, and geriatric conditions were identified using standardised assessments. Frailty was defined according to five criteria in Fried’s phenotype model and multimorbidity as the presence of two or more long-term conditions (LTCs). Comparisons with the general population were made using data from the English Longitudinal Study of Ageing and the Health Survey for England. Findings: A total of 33 people participated with a mean age of 55.7 years (range 38–74). Frailty was identified in 55% and pre-frailty in 39%. Participants met an average of 2.6/5 frailty criteria, comparable to 89-year-olds in the general population. The most common geriatric conditions were: falls (in 61%), visual impairment (61%), low grip strength (61%), mobility impairment (52%) and cognitive impairment (45%). All participants had multimorbidity. The average of 7.2 LTCs (range 2–14) per study participant far exceeds the average for even the oldest people in the general population. Originality/value: To the best of authors’ knowledge, this is the first UK-based study measuring frailty and geriatric conditions in PEH and the first anywhere to do so within a CGA-type evaluation. It also demonstrates the feasibility of conducting holistic evaluations in this setting, which may be used clinically to improve the health outcomes for PEH. (Edited publisher abstract)
The experience of older people with multimorbidity during the COVID-19 pandemic
- Authors:
- ZANINOTTO Paola, DI GESSA Giorgio, STEEL Nicholas
- Publisher:
- English Longitudinal Study of Ageing
- Publication year:
- 2020
- Pagination:
- 10
- Place of publication:
- London
The risk of severe COVID-19 disease is known to be higher in older individuals with multiple long-term health conditions (multimorbidity). In this briefing, we report the latest findings from the English Longitudinal Study of Ageing COVID-19 Substudy on the experiences of older people with multimorbidity during the pandemic. Not all people with multimorbidity would be classified as clinically vulnerable. We found that 35% of older individuals with multimorbidity were instructed by the NHS or their GP to shield (staying at home at all times and avoiding any face-to-face contact) on account of their vulnerability, and the majority were largely compliant with this advice. Relative to study members without multimorbidity, respondents with multimorbidity were more likely to report poor sleep quality, eating less, and being worried about not having enough food and other essentials. Unhealthy behaviours (sitting time, physical inactivity etc), poor mental health, and loneliness deteriorated considerably during the lockdown and in the two months following the lockdown. Access to medications among people with multimorbidity was not a problem, however, a fifth of individuals with multimorbidity did not have access to community health, social care services and support from other health professionals (e.g., dentist, podiatrist). When considering policies which advise people to shield or self-isolate because of their COVID-19 risk, it is important for policymakers to acknowledge that older people with multiple long-term health conditions are at higher risk of experiencing greater mental distress and worry, of engaging in unhealthy behaviours and are less likely to access health services when needed; all these factors together could potentially influence disease progression. (Edited publisher abstract)
Briefing: understanding the health care needs of people with multiple health conditions
- Authors:
- STAFFORD Mai, et al
- Publisher:
- Health Foundation
- Publication year:
- 2018
- Pagination:
- 26
- Place of publication:
- London
This briefing paper reports on an analysis of data from 2014 to 2016 for 300,000 people in England to examine the number of people with multiple health conditions and what needs to be done to address their complex needs. The analysis found that one in four adults had 2 or more health conditions, equating to approximately 14.2 million people in England. Over half of NHS costs for hospital admissions and outpatient visits and over three quarters of the costs of primary care prescriptions were for people living with 2+ conditions. Those in the most-deprived areas were also more likely to experience multiple long term conditions at an earlier age than those in the less deprived areas. The report sets out six steps the NHS could take to improve care for people with multiple conditions: supporting those with multiple conditions to live well; developing new models of NHS care for those with multiple conditions; resourcing the vital role of primary care; designing secondary care around those with multiple conditions; using data and sharing information to improve care for those with multiple conditions; and evaluating what works. (Edited publisher abstract)
Evidence review: the impact of an ageing population on end of life care costs
- Author:
- TOWNSEND Matthew
- Publisher:
- London School of Economics and Political Science. Personal Social Services Research Unit
- Publication year:
- 2016
- Pagination:
- 20
- Place of publication:
- London
Summarises evidence on the likely impact that an ageing population will have on end of life care costs and how this could influence future health and social care costs within the UK. Key findings from the review include: population ageing is likely to increase acute care expenditures moderately, and more strongly increase expenditures in long-term and social care; multi-morbidity and dementia are highly associated with increased health expenditure at end of life, and that prioritising medical innovations that improve quality of life and functioning at end of life, and assisting individuals to remain living at home, have the greatest potential to lead to cost savings. Following the evidence review, three end of life interventions are described which have the potential to reduce health expenditures and some of the rising costs of an ageing population. These are palliative care teams, advance care planning, and care integration for individuals with multi-morbidity. It concludes that the cost of population ageing at end of life would be a greater concern if the health and social care system failed to adapt to the needs of an older and more complex patient cohort. (Edited publisher abstract)
An adapted adult day centre for older adults with sensory impairment
- Authors:
- WITTICH Walter, MURPHY Caitlin, MULROONEY Daphne
- Journal article citation:
- British Journal of Visual Impairment, 32(3), 2014, pp.249-262.
- Publisher:
- Sage
The MAB-Mackay Rehabilitation Centre runs a Day Centre Programme whose objectives are to maintain or improve the seniors’ biological, psychological, and social health while delaying or avoiding institutionalisation. Activities include walking groups, language courses, and memory games, supervised by an interdisciplinary team. Services include rehabilitation follow-up and referrals to community resources. The present study reports on the impact of the Day Centre on the holistic health of older adults with visual impairment. Between September 2011 and October 2012, 30 newly referred clients (age = 71–98 years, M = 85, visual acuity [VA] 20/50 to no-light-perception [NLP], M = 20/126) were evaluated at intake, and after 6 and 12 months, including the Visual Function Questionnaire-14, Hearing Handicap Inventory for the Elderly, Geriatric Depression Scale, Friendship Scale, Timed Up and Go Test, and Montreal Cognitive Assessment (MoCA). In all, 19 participants completed the 1-year follow-up and continued to live independently in the community 12 months after entering the Day Centre. Only one person was transferred into long-term care. Comorbid conditions included high blood pressure, asthma, cardiac problems, diabetes, stroke, arthritis, and osteoporosis. Participants reported statistically unchanged scores on all the measures, except for improved MoCA scores, p < .05. Considering the vulnerability of this population, the data indicate that the Day Centre contributes to prevent decline in its clients’ general well-being. The increase in cognitive scores is possibly linked to practice effects and reduced test anxiety. Participation in adapted Day Centre activities, as an integrated part of rehabilitation services, may support independent living in older adults with vision loss. (Edited publisher abstract)